B-Type Natriuretic Peptide (BNP) in Patients Undergoing Mitral Valve Surgery (original) (raw)
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The American Journal of Cardiology, 2007
The purpose of the present study was to assess whether preoperative and postoperative B-type natriuretic peptide (BNP) levels could be used as predictors of postoperative complications and outcomes in patients after open-heart surgery. BACKGROUND A variety of multifactor indexes have been proposed for preoperative risk assessment of patients undergoing cardiac surgery, but they have shown limited ability and utility in accurately predicting postoperative complications, hospital stay, and mortality.
Brain natriuretic peptide is a good predictor for outcome in cardiac surgery
Acta Anaesthesiologica Scandinavica, 2008
The heart secretes brain natriuretic peptide (BNP) in response to myocardial stretch. The aim of this study was to determine whether adverse effects after cardiac surgery were associated with higher serum BNP levels pre-operatively. One hundred and thirty-five patients undergoing various cardiac procedures were included in the study, and N-terminal pro-BNP (NT-pro-BNP) was measured pre-operatively. Post-operative complications were defined as follows: (i) a post-operative length of stay in the intensive care unit (ICU) exceeding 48 h; (ii) mortality at 28 days; (iii) the need for inotropic agents and/or intra-aortic balloon pump (IABP); and (iv) renal failure. Serum NT-pro-BNP values were compared for patients with and without complications. The serum NT-pro-BNP level was also correlated with the euroSCORE and ejection fraction (EF). Pre-operative serum NT-pro-BNP levels were significantly higher in patients with an ICU length of stay of more than 2 days or death prior to post-operative day 28 (3118 ng/l vs. 705 ng/l; P < 0.001). Pre-operative serum NT-pro-BNP levels were also significantly higher in patients needing inotropic agents (2628 ng/l vs. 548 ng/l; P < 0.001) or IABP insertion (3705 ng/l vs. 935 ng/l; P = 0.001) or developing renal failure (2857 ng/l vs. 945 ng/l; P < 0.001) post-operatively. The correlation between the serum NT-pro-BNP level and euroSCORE was good (r = 0.658; P < 0.001). The receiver operating characteristic (ROC) curves were used to assess the ability of serum NT-pro-BNP, euroSCORE and EF to predict outcome after cardiac surgery. This revealed an area under the ROC curve for the length of stay in the ICU or mortality at 28 days of 0.829 for serum NT-pro-BNP, 0.814 for euroSCORE and 0.328 for EF assessed by transesophageal echocardiography, indicating that the pre-operative serum NT-pro-BNP level is a good prognostic indicator for outcome after cardiac surgery. Serum NT-pro-BNP is a good predictor for complications after cardiac surgery, and is as good as euroSCORE and better than EF.
Background. B-type natriuretic peptide (BNP) levels predict cardiovascular risk in several settings. We hypothesized that they would identify individuals at increased risk of early cardiac complications after major non-cardiac surgery. The current study tests this hypothesis. Methods. Two hundred and four patients undergoing major non-cardiac surgery were studied. The primary end-point was the development of acute myocardial injury [defined as cardiac troponin I (cTnI) level .0.32 ng ml 21 ] or death in the 3 days after surgery. Results. Preoperative BNP levels were raised in patients who died or suffered perioperative myocardial injury (median 52.2 vs 22.2 pg ml 21 , P¼0.01) and BNP predicted this outcome with an area under the receiver operating characteristic curve of 0.72 [95% confidence interval (CI) 0.59-0.86, P¼0.01]. A preoperative BNP value .40 pg ml 21 was associated with an increased risk of death or perioperative myocardial injury [odds ratio (OR) 6.8, 95% CI 1.8-25.9, P¼0.003], and remained independently predictive after correction for the Revised Cardiac Risk Index. Preoperative BNP levels were higher in patients who exhibited new onset atrial fibrillation or ST/T-wave changes on their postoperative ECG (median 50.5 vs 22.5 pg litre 21 , P¼0.01). They were also higher in patients who had either elevation of cTnI .0.32 ng ml 21 or postoperative ECG abnormalities (median 50.4 vs 21.5 pg ml 21 , P,0.001). Conclusions. In the setting of major non-cardiac surgery, preoperative BNP levels are higher in patients who experience perioperative death and myocardial injury. Larger studies are required to confirm these data and to clarify what BNP levels may add to existing methods of risk stratification.
Immediately Postoperative B-Type Natriuretic Peptide and Its Predictive Value
Annals of Vascular …, 2011
Background: Major vascular surgery involves a high risk of major cardiovascular morbidity and mortality. A method of predicting perioperative myocardial events is required. Preoperative B-type natriuretic peptide (BNP) has been evaluated for this purpose. The aims of this study were to determine the postoperative course of BNP levels and correlate these levels with the outcome. Methods: The present study included 45 patients undergoing major vascular surgery. These patients further underwent serial venous blood sampling for troponin-T and BNP and serial electrocardiograms, pre-and postoperatively (immediately postoperatively and at days 1 through 4). Results: Of the 45 patients, seven suffered myocardial damage, as defined by troponin-T. An immediate postoperative BNP (cutoff, 171 pg/mL) was better able to predict cardiac damage ( p ¼ 0.027) than BNP levels preoperatively (cutoff, 281 pg/mL, p ¼ 0.042) and on day 1 postoperatively (cutoff, 182 pg/mL, p ¼ 0.032). Only the preoperative BNP levels showed an effect on survival. Patients with a preoperative BNP >281 pg/mL had a mean survival of 12.7 months, as compared with 17.6 months for patients with a BNP <281 pg/mL, p ¼ 0.044. Conclusion: Preoperative BNP is an accurate determinant of postoperative cardiac morbidity and all cause survival, with BNP in the immediate postoperative period being an even more accurate predictor of cardiac events. An immediate postoperative BNP might help risk stratify patients for the next 72 hours in the perioperative period (and maybe longer).
Heart, Vessels and Transplantation
Objective: We aimed to define the relationship of preoperative N-terminal-pro-brain type natriuretic peptide (NT-pro-BNP) testing in routine practice of cardiac surgery with clinical, perioperative variables, surgical outcomes and complications in pediatric and adult cardiac surgery patients. In addition, we assessed relationship of NT-pro-BNP with EuroSCORE II in adult patients undergoing cardiac surgery. Methods: A total of 48 patients who underwent cardiac surgery in our institution were enrolled into this retrospective observational cohort study. According to age aspects pediatric (PG, n=20) and adult (AG, n=28) group of patients were separately evaluated. Each group further was categorized into two subgroups (group 1 and 2) on the basis of cut-off points of NT-pro-BNP level (430 and 250pg/ml in adults and children, respectively). Preoperative NT-pro- BNP was obtained from patients. Statistical tests were conducted to reveal differences in clinical and perioperative variables...
Brain natriuretic peptide a predictive marker in cardiac surgery
Interactive cardiovascular and thoracic surgery, 2009
BNP which stands for B-type natriuretic peptide is a cardiac neurohormone and is secreted in response to myocardial stress and causes natriuresis and vasodilatation. Studies have reported close correlation between a high concentration of BNP in blood and worse short-term and long-term prognosis following myocardial infarction and heart failure. In this study, we have tested its usefulness and predictive value in the outcome post cardiac surgery. Between March 2006 and June 2007, 141 patients, undergoing cardiac surgery, were enrolled in this study. Their BNP concentration was measured prior to the operation and their comorbidities were examined against their BNP levels. Postoperatively their outcome was closely monitored. Main clinical endpoints were atrial fibrillation (AF), inotrope use, renal impairment, early deaths and hospital stay. Some preoperative comorbidities, such as renal impairment, peripheral vascular disease (PVD) and low ejection fraction (EF) were associated with h...
Circulation, 2004
(postop) atrial fibrillation (AF) occurs in up to 60% of patients after cardiac surgery, leading to longer hospital stays and increased healthcare costs. Recently, B-type natriuretic peptide (BNP) has been reported to predict occurrence of nonpostoperative AF. This study evaluates whether elevated preoperative (preop) plasma BNP levels predict the occurrence of postop AF. Methods and Results-One hundred eighty-seven patients with no history of atrial arrhythmia who had a preoperative BNP level and had undergone cardiac surgery were identified. Their records were reviewed, and postoperative ECG and telemetry strips were analyzed for AF until the time of discharge. Postop AF was documented in 80 patients (42.8%). AF patients were older (68Ϯ11 versus 64Ϯ14 years, Pϭ0.04), but there was no difference in sex distribution, hypertension, left ventricular (LV) function, LV hypertrophy (LVH), left atrial size, history of coronary artery disease (CAD), or -blocker use. Preop plasma BNP levels were higher in the postop AF patients (615 versus 444 pg/mL, Pϭ0.005). After adjustment for age, sex, type of surgery, hypertension, LV function, LVH, left atrial size, CAD, and -blocker use, the odds ratios of postop AF according to increasing quartiles, compared with patients with lowest quartile, were 1.8, 2.5, and 3.7 (P trend ϭ0.03). Conclusions-An elevated preop plasma BNP level is a strong and independent predictor of postop AF. This finding has important implications for identifying patients at higher risk of postop AF who could be considered for prophylactic antiarrhythmic or -blocker therapy. (Circulation. 2004;110:124-127.)